AN UNEXPECTED ENDGAME -- THE FALLOUT FROM MASSACHUSETTS -- DEM GUT-CHECK TIME -- GOP EMBOLDENED -- NEW RULES FOR HMOS

By Chris Frates

01/20/10 06:31 AM EST

It’s Wednesday. “Send lawyers, Pulse and money. The (stuff) has hit the fan.” (h/t: A reform supporter familiar with the negotiations.)

AN ENDGAME NOT IN ANYONE’S PLAYBOOK — For Democrats, this was not how it was supposed to go. A month after they pushed health reform through the Senate in memory of Ted Kennedy, the loss of the liberal lion’s seat is now putting his legacy legislation in jeopardy — a cruel irony in a debate filled with painful twists. Democrats now have several choices — none of them good. The least likely is a move to ram reform through Congress before Republican Scott Brown is seated. The optics of such a nakedly political power play are terrible, and Democrats from liberal Rep. Barney Frank to moderate Sen. Jim Webb squashed the idea in statements last night. Democrats could also work to win the support of a moderate Republican or two, but that road led nowhere last summer and the GOP opposition to passing Democratic reforms has only intensified since then. So, Democrats are left with the option of scaling back and essentially starting over or persuading House Democrats to pass the Senate bill, likely with assurances that as many differences as possible will be worked out through budget reconciliation. The latter is a high-risk, high-reward strategy that has its fair share of supporters and detractors. But with the political playing field fundamentally shifted in the closing minutes of the game, it may be Democrats’ most catchable Hail Mary.

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HOW IT PLAYED:

THE FALLOUT — POLITICO’s Carrie Budoff Brown and Patrick O’Connor: “Republican Scott Brown’s upset win in Massachusetts Tuesday threatened to derail any hopes of passing a health reform bill this year, as the White House and Democratic leaders faced growing resistance from rank-and-file members to pressing ahead with a bill following the Bay State backlash. Democratic leaders insisted they planned to press ahead with health reform, and met late into Tuesday night in Speaker Nancy Pelosi’s office. But they made no decisions about how to proceed, now that Brown has swept away the Democrats’ filibuster-proof 60-vote majority in the Senate. Their options are few, and extremely complex, mostly involving legislative tactics that would be difficult to pull off in the best of circumstances, let alone at a time when members are worried they could be the next Martha Coakley — a seeming Democratic shoo-in laid low, in part, by health reform. And already Tuesday night, Democrats were being forced to come to terms with the prospect that their decades-long goal of health reform might once again fall short, despite getting closer to becoming law than ever before. Pelosi insisted Democrats could still make it happen. ‘We will get the job done. I am confident of that. I have always been confident of that,’ she told reporters as she left the Capitol at 11:30 p.m. … But it wasn’t clear last night how Democrats could do it, or how hard the White House is prepared to push. A statement by Press Secretary Robert Gibbs announcing that President Barack Obama called Coakley and Brown made no mention of health reform. The White House’s preferred option is for the House to approve the already-passed Senate version of health reform, to avoid the need for another vote in the Senate. But several House members said last night they’re not prepared to pass the Senate bill alone – even if it means health care reform would die. … And with the winning majority for a health reform bill in the House so thin, almost any defections at this point would be fatal to reform’s prospects.”

** The Center for Medicine in the Public Interest Advance opposes government-run health care. Is an unelected health care “czar” really any better than a public plan? Learn more at www.handsoffmyhealth.org. **

WH: GET IT DONE — HuffPo’s Sam Stein reports: “In a push to set the stage, the White House came out forcefully in favor of getting health care reform passed into law, holding the possibility of even more political damage should legislation remain unpassed. ‘We need to move forward aggressively, continuing on job creation, and on financial regulatory reform,’ White House senior adviser David Axelrod told The Huffington Post. ‘But we should finish health care because the caricature of that bill is there, and everyone who voted for it will have to live with that. The way to deal with that is to pass the bill and let people see ... the value of it. It is not just getting the achievement under the belt,’ Axelrod added. ‘I think there are tangible benefits that people will accrue across this country as soon as this bill is signed. They will have more leverage, have more prescription drug coverage, Medicare is going to be extended by a decade. ... If we don't pass it and [President Barack Obama] doesn't sign it then the caricature created by the insurance industry and opponents in Congress will prevail and everyone will have to live with that. There is no political sense to that, and I hope people will see that and move forward.’”

REFORM IMPERILED, reports NYT’s Carl Hulse: “Scott Brown’s decisive Senate victory in Massachusetts imperiled the fate of the Democratic health care overhaul as House Democrats indicated they would not quickly approve a Senate-passed health care measure and send it to President Obama. After a meeting of House Democratic leaders Tuesday night even as Mr. Brown’s victory was being declared, top lawmakers said they were weighing their options. But the prospect of passing the health care overhaul by pushing the Senate plan through the House appeared to significantly diminish. … But many House Democrats expressed deep reservations about the Senate bill. Those complaints, combined with the message sent by the Massachusetts electorate, apparently were sufficient to leave Speaker Nancy Pelosi and her lieutenants reluctant by Tuesday night about moving in that direction. Democrats now face decisions on whether to give up on the health care fight — an approach few lawmakers appear willing to entertain — or perhaps pull together a scaled-back measure and use special procedural rules that would eliminate the need for 60 votes in the Senate. But it is not clear how many of the key provisions of the legislation could be passed under such a procedure.”

COULD COLLAPSE, reports WaPo’s Shailagh Murray and Lori Montgomery: “Unless Democrats can thread a very narrow legislative needle, Republican Scott Brown's upset victory over Martha Coakley in Massachusetts on Tuesday could lead to the collapse of a health-care bill that, only weeks ago, appeared close to becoming law. … In public, Democratic leaders sought to sound optimistic that they could remain on course. ‘Whatever happens in Massachusetts, we will have quality, affordable health care for all Americans, and it will be soon,’ Speaker Nancy Pelosi (D-Calif.) told reporters after a House leadership meeting Tuesday afternoon. In an earlier interview, Pelosi asserted: ‘This will happen. This is not a casual relationship with this bill. This is a total commitment.’ But other Democrats saw a bleak landscape, given numerous polls in Massachusetts — a solidly Democratic state -- showing the unpopularity of the health-care effort. The biggest worry in the party is that moderates will now begin to back away from the legislation, fearing its political effects. ‘It's a serious problem, and it's probably back to the drawing board on health care, which is unfortunate, because everybody agrees we have to do something about health care, and so it would be unfortunate to lose this whole effort,’ Sen. Russell Feingold (D-Wis.) told a Milwaukee television reporter.”

DEMS PONDER TRIAGE, reports WSJ’s Janet Adamy and Naftali Bendavid: “Congressional Democrats faced only unpalatable options for salvaging their health-care overhaul after Republicans clinched the additional Senate vote they need to thwart the legislation — a turn that had some Democrats suggesting they abandon the health effort. House Democrats signaled their most feasible alternative after Republican Scott Brown's victory in Massachusetts was to pass the Senate version of the bill and later put through additional modifications that require fewer votes to clear the Senate. … By late Tuesday, House Democrats signaled that would be a tall order. … House Speaker Nancy Pelosi … declined to say whether she believed the votes existed for such a move.”

DEM GUT-CHECK TIME, reports AP’s Erica Werner: “It's gut-check time for President Barack Obama and congressional Democrats on their health care overhaul. A stinging loss Tuesday in Massachusetts cost Obama the 60-vote Senate supermajority he was counting on to overcome Republican procedural obstacles and pass the far-reaching legislation. The outcome splintered the rank and file on how to salvage the bill, energized congressional Republicans and left Obama and the Democrats with fallback options that range from bad to worse. A leading idea involves persuading House Democrats to pass the Senate version of a health care bill that many of them have serious problems with. Another alternative calls for Senate Democrats to promise to make changes to the bill later on. Some Democrats said their big hopes would have to be scaled back. House Speaker Nancy Pelosi refused to acknowledge that as a possibility as she left the Capitol near midnight Tuesday after meeting with her top lieutenants to discuss the way forward. Pelosi and others contend that because Massachusetts already has near-universal health coverage under a state law, the upset victory by Republican state Sen. Scott Brown to take Edward M. Kennedy's old seat could not be seen as a referendum on the issue.”

GOP EMBOLDENED, reports Roll Call’s Emily Pierce: “And Republicans were already feeling emboldened by the win, viewing it as validation of their opposition to health care and other issues the majority has pushed over the past year. ‘I think it will help to solidify the notion that the American people, all over the country, are opposed to the bill,’ Senate Minority Whip Jon Kyl (R-Ariz.) speculated before the results were in. ‘There’s no way you can spin it as not a referendum on health care — as well as other issues, but clearly on health care. And I think that will cause even more concern on the part of Democratic Members of Congress about voting for it. And of course it could have a direct impact on a vote, if there’s a vote taken here in the Senate, and [Brown] votes against the legislation, obviously.’ Republicans also contend that Brown’s victory may aid the National Republican Senatorial Committee in courting more top-tier challengers to vulnerable Democratic incumbents. ‘The NRSC is circling back with every tier one candidate who told them ‘no’ and saying, ‘Are you sure?’ and I think a number will reconsider,’ said one former Senate GOP leadership aide. Democrats appeared to be feeling the heat almost immediately. Moments after Coakley conceded the race, the health care bill appeared to be on life support, with many Democrats who supported the Senate measure’s passage in December clearly having cold feet about supporting it again.”

NEW RULES FOR HMOS, reports NYT’s Randal Archibold: “Patients in health maintenance organizations in California should see their waiting times for doctors’ appointments reduced and even their telephone calls to physicians answered promptly under sweeping new rules that, for the first time, establish time standards in medical services. California regulators said the state would be the first with such time requirements, which demand that H.M.O. patients be seen by a general practitioner within 10 business days of requesting an appointment and a specialist within two weeks. Doctors must return a patient’s call for treatment within 30 minutes and be available 24 hours a day. People with urgent needs must be seen within 48 hours. The rules, authorized by a 2002 state law but delayed by years of bureaucratic wrangling, will be unveiled Wednesday and phased in over the next year. They are meant as a big step toward speeding care for the state’s 21 million H.M.O. members, who often endure long waits for basic service. The delay to see a doctor in San Diego is 24 days on average, and in Los Angeles, 59 days, according to a 2009 survey by Merritt Hawkins & Associates, a physician recruiting firm. But even champions of the new rules acknowledge they may result in higher premium fees if, as expected, H.M.O.’s hire more doctors or incur other costs to meet the time demands. The need for more doctors could worsen if Congress extends insurance to 30 million more Americans.”

** Congressional Democrats are working to finalize health care reform legislation. As the process moves forward, the Center for Medicine in the Public Interest Advance and their national grass-roots campaign Hands OFF My Health strongly urges Congress to keep their HANDS OFF the health care decisions of American patients. Whether the public option, a federalized exchange, or an appointed health care “Czar” and new super-bureaucracy, more government control over American health care will have far-reaching consequences for patient care, medical services and the practice of medicine. Government-run health care in whatever form or whatever name will eviscerate individual choice, cost taxpayers billions and dramatically increase waiting times for appointments, tests and new procedures. Increasing access and improving quality should be the foundation of national reform, rather than government programs and new bureaucracies that will only stifle innovation and reduce treatment options for patients and providers. To take action visit www.handsoffmyhealth.org. **

** A message from PhRMA: Diabetes is a complex disease affecting more than 30 million Americans – with one-in-ten living in DC, Maryland and Virginia having the disease. Thanks to advances in diabetes care, patients around the country are living longer, healthier lives. Take five-year-old Rhys for example [link to his I’m Not Average profile]. He was diagnosed with type 1 diabetes at 15-months-old, but today, he is a thriving young boy. This is due in large part to new and innovative medicines developed by researchers and scientists at America’s biopharmaceutical companies. Learn more about the medicines in development for diabetes here. **

Authors:

About The Author

Chris Frates began covering politics before he was old enough to vote. Since his early days covering town council meetings run by three guys behind a folding table, Frates has been fortunate enough to cover government on every level.

An original Politico, Frates covers the intersection of money, politics and policy inhabited by Washington’s lobbyists and writes about national politics. During the health care reform debate, Frates wrote for the paper and was the lead writer of Live Pulse, the website’s health care reform blog. Frates also founded and wrote Politico Pulse, the popular, daily health reform e-mail briefing that quickly became Washington’s must-read crib sheet.

Before coming to Washington, Frates spent more than four years at The Denver Post where he wrote about state politics. Frates covered the 2004 Democratic takeover of the Colorado statehouse, a forerunner of the political tsunami that would hit Congress two years later, and the 2006 governor’s race.

His work has appeared in The Washington Post, The Boston Globe, The Dallas Morning News and dozens of other publications. Frates has covered three statehouses and numerous campaigns.

His political analysis has been featured on the CBS Evening News, CNN, Fox News, MSNBC, WTOP and many other national and local television and radio programs.

Of all the important people he has interviewed, Frates still counts Mister Rogers among his favorites.